30 Jun Midwife Versus OBGYN – Which is Right for You?
Midwife versus OBGYN – what’s the difference, exactly?
Many pregnant people don’t realize how much choice they have about the care provider who delivers their baby. In the United States, births can be attended by obstetrician gynecologists (OBGYNs), family physicians, and midwives. The credentials and training are different for each of these providers, and their general philosophy toward birth is likely different as well. In general, doctors will follow the “Medical Model of Care” while midwives will follow the “Midwifery Model of Care” – more about that in a second. Most births in the US (about 90%) are attended by physicians.
There is also a misconception that midwives only care for people who are having home births, or that they can only care for low risk pregnancies. That’s not true! Most midwives in the US work in hospitals and can care for all types of patients, including higher risk patients. Typically, OBGYNs are available to consult if things go sideways for a midwife or family physician during pregnancy or birth.
Here in Pittsburgh, you can find midwives to support you in a hospital, at our freestanding birth center, or at home.
Midwifery Model vs. Medical Model
Nothing about pregnancy care is black and white, so it is important to note that most providers will use elements of both care modalities. The most notable difference between the two practices is that midwives are the “experts of normal labor,” while OBGYNs are trained in surgery and in high-risk pregnancy.
From Childbirth Connection, here are some contrasts between the two models of care:
Midwifery Model of Care
- Focus on health, wellness and prevention.
- View labor/birth as normal physiological processes.
- Use interventions at lower rates, when needed.
- Emphasize that “mother gives birth.”
- Provide individualized care.
Medical Model of Care
- Focus on managing problems and complications.
- View labor/birth as dependent on technology.
- Use interventions at higher rates, including routinely.
- Emphasize that “doctor delivers baby.”
- Provide similar care for everyone.
When you’re considering what type of care would be best for you and your family, think carefully about your values and what kind of birth you are planning.
Midwife versus OBGYN – Training
- Midwives receive specialized training in the management and support of healthy people with low-risk, uncomplicated pregnancies and births. They prioritize providing good information, involving patients in decision-making, and providing flexible, responsive care. Most midwives try to avoid unnecessary tests and treatments, including cesarean, episiotomy, and medical induction of labor.
- Physician training in maternity care emphasizes expertise in identifying and managing risks and complications. Pregnant people with serious health problems or who are at risk for those problems will likely benefit from physician-led care. However, because of this focus on problems and complications, medical maternity care may give less attention to emotional concerns or to physiologic birth.
Where They Practice
- Many midwives attend births in hospitals throughout the US, and they attend most of the births that take place in freestanding birth centers or at home. Midwifery support has been gradually increasing since the 1970s.
- Most physicians attend births in hospitals, but a small amount may practice in out-of-hospital birth centers or in homes. Prenatal and postpartum follow-up care is generally provided in office settings.
Here in Pittsburgh and the surrounding areas, you can receive OBGYN-led care at any of the local hospitals. If you would prefer to work with midwives, there are groups practicing at The Midwife Center for Birth & Women’s Health, UPMC Magee-Women’s Hospital, AHN Jefferson Hospital, Butler Memorial Hospital, and Ruby Memorial Hospital. Several smaller physician practices, such as Allegheny Reproductive Health Center and Weirton Medical Center, employ a few midwives to work in conjunction with their doctors.
Midwife versus OBGYN – Types of Practitioner
Both midwives and OBGYNs have different levels of training and experience. Here in Pennsylvania, most midwives are CNMs. We do have some CPMs and lay, traditional, and Grand midwives supporting home births throughout the region.
Types of Midwife
- Certified Nurse Midwives (CNMs)
- These midwives are registered nurses who have graduated from a nurse-midwifery education program, which can grant either a Masters or Doctorate degree. All 50 states license CNMs. Most attend births in hospitals or freestanding birth centers, but may also offer support for home birth.
- Certified Midwives (CMs)
- These midwives are educated in both midwifery and other health-related skills, but are not registered nurses. CMs take the same certification exam as CNMs. They are licensed to practice in New York, New Jersey, and Rhode Island.
- Certified Professional Midwives (CPMs)
- CPMs are “direct entry” midwives who are not required to have a nursing background. They train in midwifery-specific education programs with a focus on clinical experience and pass a certification exam. Most CPMs attend birth center or home births, and their licensure is valid in most states.
- Lay, Traditional, Grand Midwives
- These providers may or may not have received any formal education, and most learn midwifery through apprenticeship with an experienced midwife. Many of these practitioners hold generations worth of cultural knowledge to support birth and the postpartum period.
Types of Physician
- Obstetricians (OBGYNs)
- These physicians have specialized training in prenatal care, labor, birth, high-risk pregnancy, and surgery. Most also provide routine gynecological care. Many approach birth as a medical event that is best managed by highly trained specialists. They tend to have higher intervention rates than Family Physicians or midwives, even when the health status/risk of the pregnant person is similar. OBGYNs have at least 4 years of practice in an obstetrics residency program after graduation from medical school.
- Maternal Fetal Medicine Specialists (MFMs)
- A subsection of OBGYNs who are trained to manage the most complex pregnancies.
- Family Physicians (FPs)
- General practice doctors who provide “cradle-to-grave” medical care and support from a family-oriented perspective. About 15% of FPs in the US attend births, and many provide prenatal and postpartum care but may partner with OBGYN hospitalists to attend the birth. FPs have at least 3 years of training and have practiced in a family practice residency program after graduation from medical school.
It’s never too late in pregnancy to choose a different care provider, and it’s important to work with one that makes you feel comfortable, safe, and supported. You can interview different groups and tour different hospitals or birth centers. Write down a list of questions that you have, and bring them with you to the interview. After you leave, think about a few things: did they listen to you? Did they take the time to answer your questions? Does this feel like the right fit for me?
So, what do you think? When you ask yourself “Midwife versus OBGYN, which do I choose?” where do you land? If you’ve given birth before, what sort of provider supported you, and are you satisfied with that experience?
About the Author:
Anna fell headfirst into birth work in the winter of 2017, after selling a spinning wheel (and a spinning lesson!) to a local birth doula. She was fascinated by the idea of supporting people through such a vulnerable time and had an inkling that she would be good at this sort of job.
Two things have become very clear during Anna’s doula career. First, there is nothing more magical than being a part of a baby’s first moments in the world. And second, a person in labor will always need a smart, creative, dedicated care team to ensure that their needs are met and their voice is heard. Every single birth has surprised her, moved her, and reinforced the passion that she has for birth work and families.
Anna lives in the South Park Township with Jake, the resident Bad Cat. When she’s not acing her nursing finals, Anna supports her clients in pregnancy, birth, and postpartum; wears many of the Boundless Birth administrative hats; teaches Childbirth and Breastfeeding education to expecting parents; and is a longtime member of a badass feminist knitting circle. Since that fateful spinning wheel sale, she has acquired several more spinning wheels and a loom or three.